Acquired immune deficiency syndrome: an update and interpretation.

It is clear that there is a distinct new clinical entity of acquired immune deficiency which manifests itself by opportunistic infections and KS. It occurs in selected groups of the population but with an ever increasing spectrum. The clinical presentation is extremely varied and the spectrum of disease runs a wide gamut. Health professionals should be aware that there is a large pool of individuals at risk for AIDS; also AIDS may manifest itself in the limited forms with mild initial signs which continue for months before serious disease becomes apparent. There is at present no specific diagnostic laboratory test to identify these patients or those at greatest risk. Present evidence indicates that once life-threatening opportunistic infections or KS have become obvious, although the disease process may wax and wane, most patients follow an inexorable downhill course. That process has not been reversed by presently applied therapies. In view of the failure of conventional and experimental therapies, the only treatment appears to be prevention of disease by avoiding risk factors. With the ever increasing number of possible risk factors identified, such avoidance becomes continually more difficult. The most pressing problem is to delineate the pathogenesis of AIDS. Until then optimal preventive and therapeutic interventions can not be instituted fully. There are a number of major unanswered questions, foremost of which is the nature of the transmittable agent. Moreover, it is not entirely clear who is susceptible to this agent. With the vast numbers at risk and growing numbers of AIDS cases, it is imperative to uncover the initial events responsible for this syndrome. From the public health point of view, it is also crucial to determine whether those individuals in the high risk groups which exhibit immunological abnormalities will, given a long enough latent period, eventually progress to AIDS/KS or whether the majority are merely a forme fruste of AIDS. Because of the major public health impact of AIDS, all physicians should be aware of and knowledgeable about this new disease process.